Second prgnancy after a 3rd Degre Tear!!

[Gillyan]

Hello

I had a 3rd degree tear with my first child, i was in total control of the pushing and no one said i needed an episiotomy but still i managed to tear. It was not nice and it took 2 hours to stitch me up in theatre. I was told at my 6 week check that i would be allowed an elective c-section next time, I don't know what to do and have read conflictiong advice on lots of sites. Has anyone had a tear and then a c-section?? Your replies will be greatly appreciated!

[Lionstar]

I also had a 3rd degree tear with my first (after an episiotomy). Am 11 weeks pregnant with a second and am planning a home pool birth. Midwife has given a tentative OK to this, but I have to see a gynae consultant first just to check that everything looks fine. Don't assume a c-section is a necessity - vaginal birth is perfectly possible as long as you had a good repair job and healed well.

[sunriseanja]

Dear Gillyan and Lionstar,

many women have a 3rd degree tear with their first baby and progress to only minor damage with their second baby.
Your tears may have been due to length of labour, position of your baby and also the possibility that your babies came out with their hand by the face or shoulder.

This time around will be totally different.

It would certainly be useful for both of you to spend some time massaging your scar tissue in preparation for the birth. Not stretching but just rubbing some plain oil into both sides of the scar. This will soften up the skin and make it more stretchable again.

Greetings,

Sunriseanja

[Gillyan]

Thanks for your advice - I think i'm worried not just about the tearbut also about what happened with hospital, I got sent home at 1am even though my waters had broken 12 hours earlier as they had no room and they said i could go all night without progressing any further, the midwife was a bit of a battle-axe so i went home only to start having really painful contractions coming 3 mins apart - i went back a 4am and they left me on ward as again no room or delivery suits free. I finally got to one and had Gas and Air which they said i was not allowed to move around with, i eventually had some pethidine and apparantly found out later i had a severe reaction to and i lost the plot, screaming my head off for a midwife ( again there weren't enough) i was left on my own a lot of the time, at one point a midwife came in and sarcastically remarked ' Having a baby are we?' i was very distressed at being left on my own and when i asked for an epidural she said she couldn't get a needle in my hand and there was no anaesatist- anyway - went on to have a massive bleed, Grace came out and the cord was round her neck twice and she had a true knot in her umbilical cord and she'd been slowly cutting herself off from the placenta so she was black and didn't breathe for a long time! All in all pretty traumatic - then having to go and be put back together. The ward was terrible they left me with Grace on my breast even though i was flat on back and had had an epidural to be stitched up - my buzzer didn't work and a tea lady had to come and take her off me! The care i received once i left hospital was brilliant but i am very very put off hospitals, sorry to ramble - it's good to hear midwives will consider home birth after a tear though! Just don't know what to do for best - I think I'm more scared of the care i will recieve rather than tearing again!

[Smithagain]

Sorry you had such a bad experience in hospital.

I had a 3rd degree tear with DD1 and the enforced separation while I was in surgery did us no good.

I asked a similar question as you when I was pregnant with DD2. The consensus was that a vaginal birth was perfectly possible and a much better option than a CS, in terms of recovery time etc. The main practical advice I had was to highlight my previous experience in my birth plan and ask for assistance in pushing gently and in a less vertical position, to slow things down a bit.

During my second delivery, the midwife was brilliant and followed my instructions to the letter. When the second stage came she got rather stern, took away the gas and air and gave me a right talking to about how "if I didn't want another tear like the last one I needed to stop swigging that stuff and do what I was told"

She talked me through a pushing stage where I was pushing very gently, on the bed, so that everything was nice and gradual. DD2 arrived safely. I did have a small tear, but much less traumatic than the last one and no major rush to stitch things up, so I had plenty of skin to skin time with DD2 and she got a good feed before the repair work started. I was home within 24 hours with very little soreness.

The only other thing to add is that I did have one obstetrician recommend that I had an "elective episiotomy", which I didn't fancy much. When I mentioned it to my community midwife she hit the roof about attitudes from the dark ages and suggest I write in big capital letters on my notes that I had not agreed to any such thing. And no more was said about that particular idea!

[hazeyjane]

I had a 3rd degree tear with dd1, after a very long labour, hours of pushing, an episiotomy and ventouse. Like you I was stitched up in theatre and then left unable to move with dd1 on my boob, not able to latch on, then a MW came and told me off because it was not hospital policy to allow newborns in bed with their mothers. I discharged myself after 3 days because I was having such an horrendous time.

When i found out I was pregnant with dd2 I was terrified (esp as she is only 14 months younger than dd1), partly because of the tear, but mostly because of my time in hospital. I found a MW who had been lovely during my labour (unfortunately I only had her for a few hours), and went through my notes with her, so that she could help me with a birth plan. She advised me to have a water birth, and made me feel much better about choosing another vaginal birth ( I had a lot of pressure to have a caesarian). I also went on the hospital tour of the ward and talkked to one of the head MW about my previous stay.

Dd2's birth was not the water birth I had planned, and I ended up with an epidural and flat on my back, but it was much quicker, and I only had a tiny tear. The stay was also better, and only for 1 night. I think it helped that i knew what to expect 2nd time round.

A friend that had a similar 1st birth to mine, chose to have a caesarian, and she also had a very positive experience. You really have to think about what you feel more comfortable with (i was far more scared of a major operation than tearing again). Also did you recover well from your tear? I think they are more likely to recommend caesarian if you have had incontinence etc.

Sorry for long post, but your post really struck a chord with me (my buzzer didn't work either, and no-one came to change or remove my catheter, it was a nightmare) and i remember how tied up in knots I was about dd2's birth, and I was amazed at how different it and I was the second time round.

Good luck

[Gillyan]

Thanks for your message hazeyjane and everyone else. I think your right that you know more second time round - I'm sure I'll be a lot more demanding as I'm not scared of these horrid midwives now! I think I just don't want to go to hospital again but with the complications last time and my little one needing help breathing I feel I've got to go in!

There were some lovely midwives and I even went on a pram push a few weeks later to save the Maternity Unit.

I suppose with a section you have to stay in longer too, I was in for 6 days last time - I'm waffling, not even seen the midwife for my first appointment yet!!

Thanks for your advice everyone!

[Jacksmama]

You've had some great advice from everyone. My DS's birth was a nightmare and I tore badly enough to need two units of blood transfused, and the repair they did was awful. In fact, I am going to need the original repair repaired. (Grrr.) Personally, I would go for the C-section. My best friend had a similar birth as you for her first and that is what she did. She said it was no picnic, recovering from a section while dealing with her 3-year-old, but it wasn't worth it to her to risk tearing all the scar tissue again. But as you said it is a major operation, AND there is every chance that, with more knowledge and ability to stick up for yourself, you'll do really well this time. Perhaps have the state of the original tear evaluated by the midwife you really liked, and find out if it's nice and pliable or very rigid, and go from there?
BEST of luck!!

[vizbizz]

I had a 3rd degree tear, and some complications along with it. A colorectal specialist I saw said that in his opinion anyone with 3rd or 4th degree tears should go with a section with subsequent pregnancies as the risks for all sorts of incontinence issues was much, much higher. In his experience the lucky ones were fine and would encourage others to go with VB, but in his experience the risk of being the unlucky ones isn't worth it.

[changer22]

I had a very similar conversation (to vizbizz) with a consultant when pregnant for the second time. I had a third or fourth degree tear, they couldn't make up their minds which but it was 'bad'. 2 hour surgery, talk of a blood transfusion, etc. Fortunately though I never suffered with any problems.

Had 2nd child as an elective section on this consultant's advice but found the recovery hard. I missed labour - bizarrely - and I hated the fact my stomach hurt and DD was a rubbish feeder. I got discharged (chucked out) after a day and a half too .

For number 3 I hired a doula and had a great VBAC experience. Huge baby, 2 weeks late, a graze to show for it and 7 hour labour.

It's a hard one to call. I have to say though that in my experience, the consultants/registrars are more pro c-section and midwives are more vaginal birth. None of the midwives I talked to seemed fazed by my past history but the consultants thought I was rather odd when I burst into tears and said I didn't want another section (although I was quite suprised by my tears too!).

[hazeyjane]

The MW that went through my notes with me for dd2, said that consultants on the whole recommend c-sections after a 3rd/4th degree tear because it is the only way that they can guarantee not tearing, otherwise the risk of tearing is actually not that much higher if you have had a previous bad tear (I guess unless you have had problems recovering from first tear).

I had a lot of pressure to have a c-section, a consultant even came in whilst I was in the middle of labour and said that if I wanted to avoid tearing i should have one. I was very glad that the MW sent him marching!